Project Summary/Abstract Child-onset systemic lupus erythematosus (SLE) confers a 20-fold higher standardized mortality rate and greater potential for cumulative tissue damage compared to adult-onset disease, yet there is a paucity of data on cardiac outcomes in this population. Acute cardiac manifestations, including myopericarditis and endocarditis, and subclinical cardiac disease, such as diastolic dysfunction and valvular insufficiency, have been recognized in adults with SLE. Long-term, SLE is associated with an increased risk of heart failure, with the highest relative risks observed in young adults with SLE compared to the general population. The risk factors for cardiac involvement at acute or chronic stages of disease are poorly understood in child-onset SLE. As a result, it is unclear whether routine or selective monitoring is warranted. Therefore, the objectives of this proposal are to utilize a large administrative database to identify risk factors for cardiac inflammation in youth with SLE, estimate the contribution of acute cardiac manifestations to subsequent heart failure, and utilize retrospective echocardiographic data in a large inception cohort of asymptomatic children with SLE to ascertain potential subclinical precursors to heart failure. Specifically, this research proposal aims to 1) estimate the incidence of and patient characteristics associated with acute cardiac manifestations in youth with SLE; 2) determine whether a history of acute cardiac manifestations of SLE is an independent risk factor for subsequent heart failure during younger adulthood; and 3) compare echocardiographic signs of diastolic impairment, a potential precursor to cardiac damage, among asymptomatic youth with new-onset SLE to healthy controls. This study will estimate the burden of clinical and subclinical cardiac disease in youth with SLE, and identify potential risk factors to determine which SLE patients, if any, warrant routine cardiac testing. This study will be the largest study of cardiac outcomes in children and adolescents with SLE to date, and will be a first step toward developing guidelines for screening and long-term monitoring to reduce the risk of heart failure and other cardiovascular outcomes in this high-risk population. Completion of the project will provide the applicant with experience and preliminary data necessary to apply for future mentored grants to study targeted cardiovascular prevention and intervention strategies.